Article 8 Section 09 Changes and Information Reported During The Certification Period

 

Table of Contents

Title

PG Cite

General

08.09.01A

Information Received

08.09.01B

Fraud Referral

08.09.01C

 

 

08.09.01 Changes and Information Reported During The Certification Period

 

08.09.01A
General

CMS eligibility continues until the end of the certification period unless the beneficiary has been determined no longer eligible for CMS prior to the certification end date. (Refer to CMSPG 15.01.01A for discontinuance reasons.)

 

Exception: Erroneous certifications (Refer to CMSPG 08.02 for additional information)

 

CMSPG LTR 14 (07/13)

 

08.09.01B
Information Received
 

When the worker receives information or becomes aware of a change that may affect CMS eligibility, the worker shall:

 

Step

Action

1

Review the case and determine whether clarifying information is needed.

2

Send informing letter HHSA: CMS-34 to the beneficiary if additional information is required.

The CMS-34:

1

Explains how the information may affect CMS eligibility and the beneficiary may need to make other payment arrangements with health care providers before the certification period ends.

2

Informs the beneficiary of any additional verification that must be provided and the specific due date for the requested verification.

     

3

Upon receipt of verifications, update the CMS case with the new information.

 

If beneficiary…

Then…

remains eligible,

CMS case remains active.

is found to be

ineligible,

discontinue CMS case according to CMSPG 15.01.

 

 

CMSPG LTR 14 (07/13)

 

08.09.01C
Fraud
Referral

If information is received after a case is granted that would have made the applicant ineligible to CMS at the initial application, the worker shall follow the instructions for fraud referrals in CMSPG 11.01 and discontinues the CMS case as appropriate (Refer to CMSPG 15.01).

 

CMSPG LTR 14 (07/13)